July 17, 2017

"... of his delaying a vote on a bill to deprive millions of his fellow citizens of health care and downgrade the care of millions more while his own surgery and recovery are fully covered by his gold plated US Senate health insurance, courtesy of US taxpayers."

While I understand the point, an entitlement is different from a job benefit.

Or here's an other example. When I was an independent contractor, Obamacare caused my monthly insurance to go from $212 a month to $452 a month. I worked hard and secured a position as a regular employee with health care benefits.

Now, I realize we have huge issues with healthcare, but Obamacare isn't the solution.

Senators and House members (and congressional staff) used to be covered by the same federal health plan (FEHB) available to any federal employee, down to the lowliest clerk. As with many private employers, three-quarters of the cost of premiums was paid by the employer (the federal government in this case) and one-quarter by the person being covered--a fairly standard arrangement.

However, when Obamacare was passed in 2010, Senators and members of the House (and congressional staff) were switched over, by law, to Obamacare exchanges. It is these exchanges that now provide the healthcare insurance so many people imagine to be "gold-plated." The reality is that these plans are purchased through the District of Columbia’s small business health options program (SHOP) exchange, also known as DC Health Link. These are reasonably good plans, but there is nothing magnificent about them.

What happens when a Senator can not perform the functions of his/her office? Who gets to decide that is the case? McConnell? The home state governor? Anybody at all? (Watching the walking dead Robert Byrd makes me think no one can.) The current AZ governor is an R, so he would most likely appoint an R given the opportunity. We all keep waiting for RBG or Kennedy to drop in their tracks, but there is a significant number of Congress critters who are in just as bad a state of advanced decay.

Single payer system will translate into universal Medicaid. I suppose some fraction of the populace will benefit from having second rate care and that some larger fraction will suffer by having longer waits for second rate care. Don't expect any movies dramatizing their plight.

It's an understandable tendency to conflate the two, as most people cannot obtain health care without having health insurance.

It is true that most people cannot afford health care without having health insurance, when they are already paying for health insurance that covers every office visit. If people didn't pay for insurance that covers everything, the vast majority of people could pay for the vast majority of their healthcare.

Of course, there are things that most people couldn't afford: stroke, significant cancer, major car accident. For those things we should have insurance.

I currently live in a single-payer system and like it well enough, Americans' fears are overblown.

But at the same time, there are aspects that are worse, enough that reasonable people can disagree about which system is preferable. There can't be a rational discussion in the US because there are too many people determined to see a particular outcome and don't care what others want or what's really objectively best.

Robert Cook said..."I'm rather tired of people who use the phrases "health care" and "health insurnce" interchangeably, and conflate the two."

It's an understandable tendency to conflate the two, as most people cannot obtain health care without having health insurance.

It is really strange that a leftist does not seem to understand the function of insurance. I know I know I am joking leftists in general seem to be ignorant of pretty much everything...

I would like any of you to explain how health insurance makes health care more available and more affordable.

If you understand what insurance is you can't because it doesn't. A company that provides insurance charges a premium to people to assume risk. Insurance by definition makes health care more expensive. It should be used to stop catastrophic issues not for everyday costs.

If there was one subject where leftists and government fuckheads weren't stealing money from everyone to pay off some crony interest like the insurance companies it would be nice to hear what that is.

"Nearly all Americans were better off before Obamacare than they are today."

"Better off" how? How do you know? By what criteria? Are there studies that prove this?

I was not an advocate of Obamneycare--a conservative-think tank invention that further enriches the already too-powerful health insurance corporations--but I don't know that "nearly all Americans were better off" before ACA was passed, while it seems a good number of Americans are better off with Obamneycare than they were with what they had before...nothing.

"I would like any of you to explain how health insurance makes health care more available and more affordable."

Most people cannot afford to see a doctor, to have necessary treatments or surgeries, to pay for necessary prescriptions, if they do not have insurance to help them pay for it, given the costs of these things. If all of these things were cheaper, perhaps insurance--itself too expensive--would not be necessary.

Most people cannot afford to see a doctor, to have necessary treatments or surgeries, to pay for necessary prescriptions,

Maybe in your neighborhood.

I spent 25 years operating on drunken insolvents, many who did not speak English.

I will grant you that office care was less available.

Here is one reason, When I first went into practice I decided to accept Medicaid (MediCal in California). What happened was my office filled up with women wanting varicose e=vein injections. Medical paid $6 for the office visit including supplies.

I finally gave up after my office manager, who was no wealthy socialite, was enraged to hear a MediCal patient complaining about how his new swimming pool got filled in a mud slide.

The County hospitals did a better job of caring for the poor but Medicaid would not pay them for care so they were badly underfunded, then the illegals came and filled the beds and the clinics

You're still confusing insurance with coverage. My car insurance doesn't pay for preventative maintenance on my car, but if I get T-boned by someone it will cover the damage to my car or to the occupants. I can afford a $20 oil change, but it's a lot harder to cover an $8,000 repair job. Catastrophic coverage is outside of normal care for my car.

Health care reform begins with education reform (e.g. separation of Pro-Choice and State, biology education) and restoration of capitalism to organically, optimally determine the cost of medical products and services in order to mitigate progressive costs. Either that or force a monopoly (e.g. single-payer) with suboptimal outcomes, predisposition to progressive corruption, and, with Democratic management, follow a progessive slope that includes [class] diversity, abortion rites, and redistributive change.

"Most people cannot afford to see a doctor, to have necessary treatments or surgeries, to pay for necessary prescriptions, if they do not have insurance to help them pay for it, given the costs of these things."

For the love of god Robert. How do you get a message through to someone this dense.

Insurance companies make a profit.

You pay more in premiums copay and deductibles than you do if you pay in cash. The insurance company makes a lot of money on 100 people so it can cover the massive cost of the 1 or 2 people in the risk pool who have a catastrophic illness.

Used to pay for daily expenses insurance companies only add paperwork and distortion to market pricing. Obamneycare made everything more expensive for everyone with less actual health care delivered to patients and made insurance companies rich while soaking taxpayers. As it was always meant to do.

You know who is lobbying against allowing insurers to offer more choices? The insurance companies. Why do you suppose that is?

AJ Lynch said...The irony is that Ted Kennedy lived just long enough to be the last and most needed vote to pass Obamacare while McCain's absence may be the thing that keeps Obamacare from being killed.

7/17/17, 2:20 PM

I think Kennedy died during the summer of Obama's Great Traveling Road Show sales job for Obamacare, when he started out by saying doctors were chopping off diabetics' feet to make a few grand(until the AMA told him to stop it), then he switched to Insurance Companies Are Ripping You Off(until the NAIC told him to stop it), then he finished the tour with the classic "If you like your insurance, you can keep you insurance. If you like your doctor, you can keep your doctor". Kennedy died in August or July I think, and Massachusetts held a special election during which Scott Brown promised to be the Vote That Stopped Obamacare, and his opponent Martha Coakley declared that it would be a sin to vote a republican into Ted Kennedy's senate seat. Brown brilliantly batted that bon mot into the grandstand by saying it that it wasn't Ted Kennedy's seat, it was the people's seat.

Anyway, the people of true-blue progressive paradise Massachusetts did their part by electing a republican to fill Kennedy's spot in the people's seat, Brown did his part by voting against Obamacare, and you know the rest of the story. A rat like Specter, a couple of saps like Nelson and Stupak, and Free HEALTHCARE!!!11!!! for everybody....

I live in one of the places where the last insurer is about to exit. It'd be nice to have a market of insurers who could offer products on their terms to people who might buy them. We do not have that. What we have is government-run health care on the sly.

Robert Cook said, "Most people cannot afford to see a doctor, to have necessary treatments or surgeries, to pay for necessary prescriptions, if they do not have insurance to help them pay for it, given the costs of these things."

The ignorance burns. You say these things, and I think you believe them, because you write them with a sincerity that shows through.

Achilles said... "Obamneycare... made insurance companies rich... You know who is lobbying against allowing insurers to offer more choices? The insurance companies. Why do you suppose that is?7/17/17, 5:49 PM

I saw some press release ballyhooed like "Insurers Warn GOP to not change O-Care". I think that was just democrat party media messaging. The following Politico article gives a pretty good summary on the status of Obamacare with insurance companies, and it's not good.

The following is a quote from the article:"But insurers also aren’t happy with the status quo. They’ve lost billions of dollars on their Obamacare customers — $7.9 billion in 2015 alone, according to McKinsey — and some of the biggest plans have abandoned the marketplaces."

The 800-pound gorilla is that we're consuming more health care, and paying more for it, than ever before. It has been going up at something like 15%/year for the last 20 years. That is not sustainable. It's reaching up toward 20% of GDP.

There are two questions in regards to healthcare.First- Should the government provide ANY healthcare to people other then military personnel and dependents? (The reason for including dependents is to keep a deployed servicemember from worrying about the family's health and allow concentration on the mission.)

Second: If YES, then how much healthcare should government provide? I'm of the opinion that if government provides any, it should be basic healthcare only. Antibiotics and treatments for infectious diseases that can be treated by them, for anyone inside our borders, legal or not. Immunizations against disease. Painkillers for those in need. You've got lung cancer? Your're a smoker? Hope you bought insurance. If not, government will provide painkillers when it gets to bad. Mountain climbing? Fell off a cliff? Here's the bill for your rescue. (Being done now in some jurisdictions.) And here's the bill for fixing you up. Hope you bought insurance.

That sounds great, mutaman. My premiums have increased by approximately 200% in the last seven years. How did you manage to get such a discount? I need to get into that business. My five dependents would benefit as well.

The two big problems the French are having is that the system is funded by payroll deductions, like here, but unemployment is so high that too many have to use the system for the poor. That is draining the coffers.

The other is that the English, who are retiring to France in huge numbers, are also signing up for the system for the poor. They refuse to go home to the NHS even though it is an hour ferry ride or a half hour Eurostar ride.

There are web sites to teach British immigrants how to sign up. The problem is that they have never contributed.

Michael K said..."Brown did his part by voting against Obamacare, and you know the rest of the story. "

If I remember correctly, they would not swear Brown in until the reconciliation caper was complete. Had he been sworn in, he could have voted against it.

Correct me if I am remembering that wrong.

7/17/17, 6:29 PM

You might be right about that. Kirk, a democrat was Kennedy's placeholder until the election. And ultimately the passage of the law came down to the house, right? The Stupak amendment or something. The senate bill had already been passed with The Cornhusker Kickback.

I currently live in a single-payer system and like it well enough, Americans' fears are overblown.

Perhaps you don't mind being a ward of the state. But many people do not want to be reduced to the status of dependent children. They don't want the government involved in their medical care at all. They want the government to just leave them alone as free people.

Here in Nevada there is heavy air play of TV ads to pressure Sen Dean Heller (R-NV) to Save Our Healthcare. Presumably, Las Vegas will have to buy snowplows to clear the piles of rotting corpses from the streets if he doesn't. My question: who pays for these ads, and who benefits ?

You might be right about that. Kirk, a democrat was Kennedy's placeholder until the election. And ultimately the passage of the law came down to the house, right? The Stupak amendment or something. The senate bill had already been passed with The Cornhusker Kickback.

The bill had already passed the Senate with Kirk's vote and Reid used reconciliation so that no additional Senate vote would be required. No one had heard of this maneuver and voted for Brown believing the consolidated bill would have to be approved by both Houses as is normally done.

MA voters put Brown in office to stop the bill and Harry Reid nullified their vote. Remember that when the Dems tell you they're "for the people".

Should the government provide ANY healthcare to people other then military personnel and dependents?

I don't have a problem with some minimal level, you don't want the poor dying in the street. ( Think of what that would do to the morning commute! )

But we are doing things ass-backwards. We are overcharging the young to keep rates down for the older but not quite to retirement age people, and withholding from worker's paychecks to pay for retirees. The way I see it, society's interest in me staying alive ends when my children become adults.

I did a search for "McCarren Act", and I discovered something unrelated to national security, but relevant to medical reform: The McCarran–Ferguson Act.

a United States federal law that exempts the business of insurance from most federal regulation, including federal antitrust laws to a limited extent. The McCarran–Ferguson Act was passed by the 79th Congress in 1945 after the Supreme Court ruled in United States v. South-Eastern Underwriters Association that the federal government could regulate insurance companies under the authority of the Commerce Clause in the U.S. Constitution and that the federal antitrust laws applied to the insurance industry-- wikipedia.org

and

One aspect of Republican proposals for healthcare reform in the United States is allowing interstate competition for health insurance, potentially requiring modification of the McCarran–Ferguson Act.[21] In February 2010, the House of Representatives voted 406-19 to repeal the McCarran–Ferguson Act with regard to health insurance.

The proposed path to reform is first to address costs. The thesis is that medical products and services are unregulated by market conditions and are overpriced. It's not that the government programs necessarily underpay, but that private insurance overpay, and the costs are shared among subscribers and cash on delivery consumers.

I wonder if market regulation can be restored in two major industries without causing cascading effects and forcing massive dislocations in the general economy.

It would have been better for them to run the experiment at the state level and demonstrate viability. Instead, they forced a suboptimal solution a la Fannie/Freddie, and thereby demonstrated the incongruity of the mandate. Worse, they persist to conflate education reform with medical reform with insurance reform (i.e. Obamacare), as if there is a one to one relationship.